Recording of a global webinar hosted by Friends of the Global Fight on December 12th, 2023, World UHC Day.
Panel discussion featured global health leaders, implementors, donors, private sector and civil society, including:
Dr. Sabeen Afzal, Deputy Director Programs/Health System, Ministry of National Health Services, Regulation and Coordination, Pakistan
Mustapha Bittaye, Director of Health Services, Ministry of Health, Gambia
Sarah Boulton, Global Funds Department, Foreign, Commonwealth & Development Office, Department for International Development (DFID) United Kingdom
Robert Hecht, President, Pharos Global Health Advisors
Shunsuke Mabuchi, Head of Resilient and Sustainable Systems for Health (RSSH) and Pandemic Preparedness and Response Technical Advice and Partnerships, The Global Fund
Maurine Murenga, Representative of affected communities; former member, Global Fund board
Max Seunik, Chief of Staff, Zenysis Technologies
Moderated by Chris Collins, President and CEO of Friends of the Global Fight
Learn more at theglobalfight.org/UHC
Chris Collins: today’s webinar is based on a report led by friends of the global fight that came out last month looking at the global funds work to strengthen health systems and play a key role in advancing towards universal health coverage.
Chris Collins: I’m going to make some key points related to the report, and just walk you through that very briefly.
Chris Collins: And then we’re going to hear from each of our speakers for about 5 min each, and then hopefully, we’ll have 15 min at the end of this session for Q. And a. From the audience, and feel free at any time to put your questions or comments into the Q. And A. Box, and we’ll be reading from those at the end of the session.
Chris Collins: Thanks very much so. Can we have the slides. Chris Collins: Alright. Chris Collins: So this is the report that came out last month, and you can see there is a link to that. There. We encourage you to go and take a look at the report yourself. Chris Collins: Next slide, please.
Chris Collins: So the Global Fund is, and always has been, focused on ending the epidemics of Aids TB. And malaria, and the Global Fund partnership has made great progress. Against all 3 of these diseases.
Chris Collins: In fact, it’s that progress and that work. Battling aids Tb and malaria. That is itself a really important contribution to advancing universal health coverage. Chris Collins: But through its more focused work on Http and malaria. The Global Fund has also made important impacts on health systems.
Chris Collins: Often it’s not acknowledged as a critical player in Uhc, for example, in the political declaration of the high-level meeting on Uhc this summer, this September the Global Fund was only mentioned in passing. But what we want to talk about today is how the Global Fund actually plays a really critical role in the future of Uhc. So we wanted to take a closer look at its work on core aspects of health systems next slide.
Chris Collins: And you can see this visual from the report looks at the 10 areas of the health system that we looked at and the Global Fund’s contribution in each of them.
Chris Collins: And this lines up with the Who building blocks of health systems. So the report looks at laboratory capacity, engaging community actors, strengthening the healthcare workforce health information systems Chris Collins: ensuring supply of medical products. medical oxygen. Chris Collins: catalyzing domestic public sector investments, strengthening governance.
Chris Collins: placing human rights, gender and equity at the center of health and engaging the private sector. All those areas are related to who building blocks of a health system. And we all look at the Global Fund’s contribution in each of those areas with many country-specific examples in each one of those next slide please.
Chris Collins: The report also found that the Global Fund has real relevance to health systems and Uhc, but it’s not just about strengthening former formal aspects of health systems, but also about the value set the Global Fund brings to its work, and that, we argue, is critical across health
Chris Collins: more broadly, including in health systems and universal health coverage. And in pandemic preparedness. And you can see some of those areas we identify that are really in the value set of the Global Fund that we think are critical.
Chris Collins: Across all health evidence-based programming community systems, human rights based approaches oversight, a focus on results, multi stakeholder engagement incentives for domestic resources and reaching key and marginalized populations. Chris Collins: Next slide.
Chris Collins: It’s also important to say that in addition, the Global Fund has real impact on global public goods in health in multiple areas. This infographic identifies 3 of those areas pooled procurement mechanisms, health management information, logistic management for supply chains. Chris Collins: Next slide.
Chris Collins: another area where the Global fund has broad impact is its growing support for community health workers. And this is discussed in the report. This investment is an example of how investing in people and in capacity to respond to health’s needs. To day enables communities to provide health services and be better prepared to identify and respond to new disease threats next slide.
Chris Collins: And this is really the take away message from the report. Investment through the Global Fund is certainly not the only pathway to universal coverage at all. But this analysis suggests that it will be an indispensable partner partner in achievement of this goal.
Chris Collins: Given its dramatic success in fighting Htb. And malaria its track record of investing in cross-cutting systems and its unique model emphasizing results, equity and engagement. The Global Fund should play a central role in global efforts to achieve access to quality health services for all Chris Collins: next slide.
Chris Collins: And here’s our lineup
Chris Collins: for today’s session. We’re first going to hear from Shunsuki Mabuchi. He is the director of resilient and sustainable systems for Health and pandemic preparedness and response at the Global Fund. Then we’ll get 5 perspectives from implementers from a donor from the private sector and from a community leader and
Chris Collins: Then we’ll have an expert wrap up. From what we’ve heard I again would ask the speakers. Each of you please stick to 5 min each, and I will let you know if you go over with no further ado. Let’s take those slides down and then shun. Please go ahead.
Shunsuke Mabuchi: Thank you, Chris, and fastable huge. Thank you for the friends of the global fight for developing a great report and also organizing this webinar. It’s a great honor Shunsuke Mabuchi: to open the session with great panel members for country partners and privacy and civil society
Shunsuke Mabuchi: as they can provide strong country and community perspectives. I will share some high level strategic overview and direction of the Global Fund work for our health system and universal health coverage. Shunsuke Mabuchi: Not.
Shunsuke Mabuchi: as the friend’s report said, there are 2 really important ways that the Global Fund, significantly and uniquely, can contribute to universal health coverage first is through effective control of HABT. B. And malaria.
Shunsuke Mabuchi: A critical aspect of U at sea is providing health services to prevent and treat the deadliest infectious diseases. Since its establishment in 2,002, the Global Fund partnership has saved 59 million lives and reduced the combined death rates of the 3 diseases by more than half.
Shunsuke Mabuchi: This is tremendous contributions, and we will continue focusing on ending HBTB. And malaria as public health threats. The second way it contributes to U Atc is through its health and community system, strengthening. As Chris introduced.
Shunsuke Mabuchi: the Global Fund is the largest multilateral provider of grants for health system strengthening. it has invested 1.5 billion dollars a year in health and community systems in the past 3 years.
Shunsuke Mabuchi: And now, with the shift of our COVID-19 response funding. we will be able to provide about 2 billion dollars a year in health system and economic preparedness and response
Shunsuke Mabuchi: in the next 3 years. This is an unprecedented scale up over our health systems on PPR. Investments in global Hunt’s history. Shunsuke Mabuchi: So, given the size and well established country owned platforms Shunsuke Mabuchi: and expertise and partnership we have been building.
Shunsuke Mabuchi: I would say the International, as an international funding mechanisms. It’s a World Bank and a global fund that are really main finan for the Health Systems and Universal Health coverage.
Shunsuke Mabuchi: And, more importantly, the Global Fund’s Health Systems and PPR. Work has unique capabilities that we are really working to maximize, to better contribute to you at sea. I will highlight 3 main things. First is our ability to work with the government, private sector and communities
Shunsuke Mabuchi: like the World Bank, we fund the government directly for them to implement country programs. In addition, we have really strong partnership with community based and community led organizations that can provide people centered services to marginalized populations. This is a critical feature of the Global Fund as a core part of the USC. Is equity and inclusion.
Shunsuke Mabuchi: Second, is our unique ability to leverage and integrate disease investment to build systems. Shunsuke Mabuchi: This is our critical direction. Shunsuke Mabuchi: as our disease investments are huge, and if we can more intentionally integrate them to strengthen the country’s public health functions.
Shunsuke Mabuchi: it will increase efficiency and sustainability of HBTB. And malaria investments, and also significantly contribute to HC. It’s easy to say difficult to do. But that’s a really important direction going forward for the Global Fund. Shunsuke Mabuchi: Third, an important area that the report highlights
Shunsuke Mabuchi: is its ability to support key functions of the health systems that contribute to HIVT. B. And malaria and new sea outcomes Shunsuke Mabuchi: that includes health workers, including community health workers, laboratories, supply chain data systems, community systems.
Shunsuke Mabuchi: and also with C 19 Rm resources. And we stepped up to support early warning surveillance and response systems on oxygen and respiratory care system as a Shunsuke Mabuchi: core part of the funding, preparedness and response. Work!
Shunsuke Mabuchi: What is important are what we need to really further improve our ability to support Shunsuke Mabuchi: is the support critical functions strategically long term in 10 year horizon. Shunsuke Mabuchi: through multi cycle funding.
Shunsuke Mabuchi: strengthening health systems and public health functions takes time. So maximizing our ability for strategic long term funding is really really important. Shunsuke Mabuchi: So I must say that these are all work in progress and the direction that we are taking. With much more improvement, we need to make happen.
Shunsuke Mabuchi: The next 2 years will be extremely important for the Global Fund and a partnership to demonstrate results and its contributions to in Russell health coverage, so many challenges ahead. But I’m really excited about it. Shunsuke Mabuchi: Thank you. Please back to you.
Chris Collins: Thank you so much shun that was. That was a great introduction, and thank you for staying within 5 min, like great
Chris Collins: next we wanna hear 5 perspectives from some great speakers. The first is Dr. Sabine Azal. She is deputy director of Programs, health system at the Ministry of National Health Services, Regulation and coordination in Pakistan. Dr. Azul, it’s great to have you with us. Thank you so much. Please go ahead.
Dr. Sabeen Afzal: Thank you. And good morning. Good evening, and good afternoon, everyone depending on what time zone you are in. Dr. Sabeen Afzal: I hope you can hear me, Claire.
Dr. Sabeen Afzal: thank you for giving this opportunity to Pakistan Pakistan experience. Early in 2,000 when Global Fund was created. There was more focus on vertical disease focus. But Hans, Global Fund
Dr. Sabeen Afzal: mit Ctl. And funded the 3 diseases and help and facilitated Pakistan in prevention, diagnosis, management and treatment of these diseases. Despite having a disease focus, the health system approach has always been embedded in grant making and in implementing these disease focus activities in
Dr. Sabeen Afzal: country. If I talk about linking with the Uhc. Usc. We always talk about Phc and Uhc, so Global Fund supported at all level of healthcare facilities, including the primary healthcare. And if we look at some of the activity that global burn had been supporting in Pakistan 100
Dr. Sabeen Afzal: primary healthcare, including the training of the primary health care staff and providing medicine and equipment for screening and referral of the patients and their management and treatment. Pakistan has a very large scatter of community health worker. The Lady Health Worker and Global Fund has been engaging
Dr. Sabeen Afzal: in Pakistan with the Gleti health worker for identifying the present cases of Tb. And referring them to the healthcare facility for treatment. And these Ledi health worker has also been trained for supporting TV dots. In Pakistan.
Dr. Sabeen Afzal: Another area. That I would like to talk about is the data and digital information system. I think the Global Fund paid. The pathway of DH. Is 2 in Pakistan, and it was the first support that came to for shifting from dhis to dhis, too, for the 3 diseases. But now it has taken.
Dr. Sabeen Afzal: you know, or the routine health system has also been shifted to dhis too Dr. Sabeen Afzal: well we it. And we also in Pakistan back in 2,016 and 17 there was a separate health system. Grant was also offered with Pakistan secured, and it helped us in
Dr. Sabeen Afzal: assessing and bringing efficiency not only in the disease program, but overall using the pool procurement mechanism the financial mechanism, monitoring mechanism and supply improving the supply chain mechanism. One of the thing that later help us in Covid was that combined very state of of art warehouse
Dr. Sabeen Afzal: which help us in that. I think. And the recent the Global Fund has taken from is while keeping it to these focus being part of the integrated
Dr. Sabeen Afzal: a National Health support program as a part of the Multi Donor Trust Fund which focus on redefining and reforming the primary health care. In Pakistan. However, we have, there are few challenges which need more strengthening. There are areas which need to work more like using the government fuel security mechanism and strengthening of the Ccm. And
Dr. Sabeen Afzal: the oversight mechanism in in the country together. I think we can work very well towards improving the moving towards universal healthcare services. And together we can all work to strengthen primary healthcare or to achieve Usc, I’ll stop here. Thank you very much.
Chris Collins: Wonderful. Thank you. So much, Doctor Ozol, for that presentation. Next, we’re going to hear from Doctor Mustafa Battier. He is Director of Health Services at the Ministry of Health in the Gambia. Welcome, doctor. Mustapha Bittaye: Oh, thank you very much. Mustapha Bittaye: please.
Mustapha Bittaye: for organizing this, and we really appreciate it. I don’t need to talk Mustapha Bittaye: about the games that we have Mustapha Bittaye: achieve in the 3 diseases Mustapha Bittaye: because it is immense. Mustapha Bittaye: for example, in the Gamba it used to be endemic Mustapha Bittaye: for malaria.
Mustapha Bittaye: so everybody expects to have malaria, almost everyone once at least once in every year. But now we are on the verge of elimination of money. Mustapha Bittaye: But the report is important, like you should. because not only trying to eliminate the 3 diseases or to achieve a significant reduction.
Mustapha Bittaye: but in the process we are empowering our for her system. Mustapha Bittaye: and not only for the 3 diseases, but for all the other diseases. This can be shown in many ways. For example. Mustapha Bittaye: in the Gambia. before. Mustapha Bittaye: you know, especially Covid.
Mustapha Bittaye: we do not have any medical grade oxygen generated in the country, so all the medical grade we used to import, and we had a factory that that was producing industrial grade oxygen, you know, and that’s what we mainly depended on our oxygen concentrators.
Mustapha Bittaye: But when the covid came in, so there was moratorium from all countries. So you cannot get. Mustapha Bittaye: you know, accident, even if you had the resources or the money to buy. It was very difficult. So what happened is now, global phone with other partners
Mustapha Bittaye: like the World Bank and the UN have really stepped in and supported us, to have now oxygen plants in the country. and this has really gone a long way, because previously she and had to rush on the oxygen. So oxygen in the.
Mustapha Bittaye: There was only not given Toley who needed it, but it was given to the people who needed it the most, because you had to rush on
Mustapha Bittaye: but now, with this support that was meant to help in the Covid Covid is long ago now. But you know we are all benefiting from this, and it’s going to be sustained.
Mustapha Bittaye: And the remarkable way it was done was built in sustainability, because what has happened is that we had a contract where for the next 4 years we had a contract with the supplier to maintain machines Mustapha Bittaye: for the plans, and why should we train our individual part of the
Mustapha Bittaye: for each
Mustapha Bittaye: machine is to 3 and 4 to 8 people who will be able to maintain? And right now, within this 4 years, that’s for our skills, learning on the administration and others. So really is a super project that the Gambia is very proud of. And we thank global phone and all the partners who contributed to make this happen.
The other important Mustapha Bittaye: project that we really grateful that is handled through the Ssh system is the our laboratory spokes network system Mustapha Bittaye: very flat and long. So what happens is that for patients to do tests even for the 3 diseases.
Mustapha Bittaye: It used to be difficult, because they have to travel across the region sometimes to meet the facilities that can do specific tests. Mustapha Bittaye: So it was not sustainable to have collaborative tests in every yeah facility, because some of them as partly populated. And I do not, because, if thank you.
Mustapha Bittaye: So we develop now Mustapha Bittaye: a simple referral for our network, which is like a spokes like system where samples are collected from. You know, hinterland regularly brought to one area where it is regularly correct.
Mustapha Bittaye: And Google phone is supporting this. This has really helped in out of pocket spending for people today in time, you know, annually samples I have. Mustapha Bittaye: This is really marvelous. And this is something that other countries can benefit
Mustapha Bittaye: global phone, because now we are not using it for transport and some samples of one day 3 diseases. But it’s a system that is developed to help the whole populace. Mustapha Bittaye: Another good one we have is the last mile support we got from Google phone.
Mustapha Bittaye: You know, we used to have the pool system Mustapha Bittaye: once we get all these logistics and all the supplies to regional stores. So it depended on the facilities. Mustapha Bittaye: So that last mile to get them Mustapha Bittaye: And the supplies is all very difficult.
Mustapha Bittaye: Still, not yet 100% sorted out. But we are so happy with the support we got from global phone to help strengthen this. So we are going. It’s been improved, although it’s not yet 100%. And associated with this is the elms system, which is electronic
Mustapha Bittaye: it’s helping us to be able to from our offices at the central level to be able to monitor. Mustapha Bittaye: You know how this talk is moving, where is going, and so that we can have Mustapha Bittaye: transparency and supervision, and also ensure that stockhouse pro prevent.
Mustapha Bittaye: So we really really think that this type of investments. Mustapha Bittaye: you know, in helping the health sector to strengthen all over is is really important, and sometimes it’s not well recognized by Mustapha Bittaye: by partners everywhere. So the other area we really have support is through the
Mustapha Bittaye: our community held worker systems. So global phone is helping us to train them. Mustapha Bittaye: And we have about 2,000 blages in the country. And, you know, divided into circuits. Mustapha Bittaye: So each apple range is between 5 to 10 bullets.
Mustapha Bittaye: So we are trying to ensure that we have a Mustapha Bittaye: very good network of ensuring that people in the village are trained, and you know, can give certain services and the resources providers
Mustapha Bittaye: helping in this. And one problem we have in that area is enumeration. We think that Google phone will really support in this. But the government wants to take it up, you know. But processes are going on and we are happy that the global phone is helping with the 4 steps.
Mustapha Bittaye: So once we take it up and make it? You know they are. Then we can hold them accountable. Global phone is helping to strengthen that. They are training them, they giving them tools they require.
Mustapha Bittaye: And this is really going to help not only 3 diseases, but all diseases that wonderful. So we have. Yes, thank you very much, Doctor Pittier. Those are fantastic examples. If you don’t mind, I’m gonna move on to our next speakers, and then we can come back at QA. Thank you so much for your time.
Chris Collins: Thank you. Now, we wanted to get a perspective from a donor, and we’re very pleased to have Miss Sarah Bullton with us. She is Global Health Funds team leader
Chris Collins: at the Global Funds Department, Foreign Commonwealth and Development Office in the United Kingdom. Ms. Bolton thanks so much for being with us.
Sarah Boulton: Thank you very much. Thank you for inviting me to speak today to such an important subject, because, as we look back on the learnings from COVID-19 and forward to the challenges of climate change.
Sarah Boulton: It’s clear that strong and resilient national and community health systems are critical for protecting and promoting better health outcomes.
Sarah Boulton: And thank you also to the friends of the global fight for conducting your review of the Global Fund’s contribution to Uhc and stronger health systems. It’s a great paper and a really helpful addition to the evidence and thinking around the Global Fund’s role on this agenda.
Sarah Boulton: So as you note in your paper, the Global Fund is one of the biggest multilateral health actors and a major investor in health systems. So it’s critical that we collectively make the best use of that resource.
Sarah Boulton: Many of you will be aware that the Uk. Recently published a white paper on International Development. The paper sets out a transformative new vision for how Uk development assistance should work Sarah Boulton: at its core. Our new approach is about partnership, shaping narratives which developing countries own and deliver.
Sarah Boulton: So we have spent the last year, listening to partner countries tell us how they want the global health architecture to evolve.
Sarah Boulton: And they’ve told us they want global health initiatives to accelerate their contribution to building resilient health systems, to align behind national plans and to embed sustainability at the heart of their operations.
Sarah Boulton: Their call for action has been set out today in the Lusaka agenda, which sets out a renewed vision for global health to deliver sustainable impact within the changing international context.
Sarah Boulton: In support of this agenda. We want to accelerate 5 key shifts in how the Global Fund and other global health initiatives work to support countries to strengthen health systems. First, we need all health partners to more effectively support integrated delivery of services aligned behind one national plan.
Sarah Boulton: 1 s. we need to strengthen alignment of all partners behind the objective of financial and programmatic sustainability. supporting movement towards increased domestic spending on health. Sarah Boulton: Third health partners need to adopt joint approaches to support expand and complement the reach of public and private sector. Providers, including community led organizations
Sarah Boulton: coordinating program to reach the most vulnerable are marginalized.
Sarah Boulton: Fourth, the core governance and operating models of the global health initiatives need to evolve to ensure structures and processes, impose a minimal burden on countries, offer improved efficiency at scale and are continually responsive to the needs and voices of countries, communities, and civil society Sarah Boulton: and fifth
Sarah Boulton: health partners should coordinate and play an active role to ensure that fit for purpose, quality health products are developed and manufactured for underserved regions.
Sarah Boulton: So what does the Lusaka agenda mean for the Global Fund? I think the first thing to say is that these shifts are already very largely included in the Global Fund strategy.
Sarah Boulton: The strategy puts much more emphasis on integrated people centered services. Greater emphasis on achieving programmatic and financial sustainability seeks to develop a more systematic approach to supporting the development and integration of community systems for health Sarah Boulton: and places. Greater focus on accelerating the equitable deployment of and access to innovations.
Sarah Boulton: What’s different about the Lusaka agenda is the priority that countries are placing on, not only accelerating these shifts, but also doing them together with other partners and aligning efforts behind country and community led strategies.
Sarah Boulton: The Global Fund is, as you know, already, an expansive partnership organization which includes the World Bank. And the who. What countries are asking is that the partnership expands to include all health partners, including Gavi and the global financing facility.
Sarah Boulton: And they want that expansion to be not only at the strategic level, but also the operational level. They want genuinely joined up programming to support and strengthen health systems in line with national and community priorities. That’s a big challenge. It’s a challenge to the Global Fund. And it’s a challenge to all of us as funders, implementers, and advocates.
Sarah Boulton: So we look forward to working with all of you, to take this forward and to get it right. Sarah Boulton: because we believe that this is how the Global Fund and others can make the best contribution to universal health coverage and stronger health systems. Sarah Boulton: Thank you.
Chris Collins: Thank you so much? Ms. Bolton, for that comment, really appreciate that. And and for bringing in the latest dialogues on the global stage about what’s going on. I do. Wanna remind everybody in the audience there’ll be QA. At the end. And please put any questions you have in the QA. Box, and we’ll get to as many of those as we can.
Chris Collins: Next, we’re going to hear from Max Soonik, who is chief of staff at Zenesis, and he’s going to give us a private sector perspective on the Global Fund. And, Uhc, Max.
Max Seunik – Zenysis Tech: thanks Chris and kudos for an excellent report. So, hey, folks, my name is Max. As Chris mentioned, I’m the chief of staff at Zenesis. We’re strategic partner of the Global Fund since 2,018, and also a mission driven technology company.
Max Seunik – Zenysis Tech: I wanna focus today on just one kind of overarching idea trust drawing on some learnings from our 8 year journey, supporting public sector partners in 15 countries to improve data, driven decision making for HIV malaria, but also health system strengthening overall.
Max Seunik – Zenysis Tech: We, of course, focus on one of the Uhc building blocks, health information systems, through technology that harmonizes fragmented data systems for advanced data use. I Wanna dive right into what we see as one of as the key to effective engagement of the private sector, particularly for Uhc, which, in our view, the Global fund is already leading and poised to take further. I’ll also offer some critiques of of the private sector. I know everyone loves that.
Max Seunik – Zenysis Tech: First. Let’s be super crystal clear. People must always win in any engagement between the private and public sector. Profit. Objectives must align with the objectives to maximize the health of communities. We reject the scarcity mindset that drives resources away from 3 diseases. And also, you see.
Max Seunik – Zenysis Tech: but we also have to recognize the constrained operating environments of our partners. The truth is, poor coordination among private sector companies further consumes the limited resources and time of our public sector partners on the front lines. That’s why equally determined. Uhc. Goals is so so paramount.
Max Seunik – Zenysis Tech: Competition is important. Yes, but let’s compete not only on the quality of our offerings, but also to be the best possible health partner for us at Zenesis. This means co-creating next generation technology and services that equip our partners to rapidly close the most intractable Uhc gaps and leave no one behind.
Max Seunik – Zenysis Tech: The Global Fund gets this frankly, and they support this type of effective collaboration with catalytic funding. For example, in South Africa, our partnership for advanced data collaboration boosted art linkage from 60 to 90% for sex workers, a Miss and marginalized community often cited in Uhc as a as a roadblock to Uhc. Within just one year
Max Seunik – Zenysis Tech: in Rwanda. Support has enabled a partnership with the government there to bring advanced and advanced data analytics down to the community, help level for the first time, reinforcing not only TV follow up but also overall data use meeting mixed goals.
Max Seunik – Zenysis Tech: Now, we need to recognize another reality. It’s costly for innovators to adhere to high ethical standards, but also crucial for success meeting. Uhc.
Max Seunik – Zenysis Tech: this is where the Global Fund also plays a crucial war role in shaping markets and coordinating ethical private sector actors. Few other entities have the value set, as you said, Chris, or size to do so effectively. I often hear the private sector refer to as an engine of innovation. Yes, that’s true.
Max Seunik – Zenysis Tech: But this is also true for the public sector, particularly when decision makers are properly enabled by private sector innovation, whose incentives, governing structures and tools are designed to further rights based approaches to health service provision.
Max Seunik – Zenysis Tech: This requires alignment and coordination across sectors. The Global Fund operates something called the Tech collective, to which Zenesis belongs. At a line grouping of Tech, a tech actors from specialized companies like Zenesis all the way up to Microsoft, where we work together to reinforce nationally determined strategies supported by an absolutely fantastic private sector engagement team
Max Seunik – Zenysis Tech: for us, prioritizing alignment means we work with a country’s existing investments in their data infrastructure connecting to things like Dhs 2 rather than imposing a competing system. And I think it’s time we take a firm stance across. We should decenter private sector actors who do not reinforce locally determined and publicly coordinated Uhc. Agendas and reward. Those who do.
Max Seunik – Zenysis Tech: The reality is global health and and healthcare writ large is rife with private sector. Actors content with the status quo for many profits have surged over the COVID-19 pandemic. But we have to ask, Where have the corollary outcomes for health systems and people been. This year we learned the Uhc Service Coverage Index has increased only 3 points since 2015.
Max Seunik – Zenysis Tech: So I say no more to the status quo of mixed sector collaboration. And I know that the Global Fund is leading the way on this as well. This new vision of collaboration, which is why we pledged 5 million dollars at the Seventh Global Fund replenishment alongside a number of the other companies involved in the Tech collective
Max Seunik – Zenysis Tech: and in other groupings with the Global Fund supports. So just to conclude, I think we should fortify the types of collaborations that elevate country leadership and state a latter part of this decade towards a future where you Hc. Truly is a reality for everyone. Thank you.
Chris Collins: Thank you, Max, so much for those comments, and also for all the great work that Genesis is doing. And now, with a community perspective, we’re thrilled to have Maureen Moreanga. She is representative of affected communities. She’s a former member of the Global Fund Board, and I’m very happy to say, a member of the friends, the Global Fight board. Welcome, Marine.
Maureen Murenga: Thank you very much, Chris, and thank you. Everyone for the really rich insights. Thank you, friends of the global
Maureen Murenga: fight for the report, which is timely and what is really needed at this time. And I’m really happy to be part of these conversations and to see people talk about the results of what Global Fund has done that is contributing to universal health coverage.
Maureen Murenga: II was diagnosed with HIV. In the early 2,000, and the history, then, is that our hospitals were unable to manage the numbers. So if you became sick,
Maureen Murenga: or if you went into what they called Stage 4, your family or your friends would be called to take you home and and take care of you at home.
Maureen Murenga: and because it was a stigmatized disease, families never came. So it is us who went for our peers. We learned how to provide palliative care, and we watched them die, sometimes with dignity, sometimes not. Yeah. It was sometimes even difficult to get a pain killer. And so we watched people die in pain. And th, these are very dreading moments every time there’s a global Fund replenishment. We think that if it doesn’t happen.
Maureen Murenga: then we may go back to those days because our countries are still fighting with the fiscal stage of taking up the 3 diseases. So
Maureen Murenga: through that process. The groups that were providing, or the peers or people living with HIV that were providing palliative care are the ones that were converted to community health workers and the concept of community health workers came into very many countries. And this is what is currently being used for primary health care and what many countries are coming as universal health coverage.
Maureen Murenga: And and we have seen Global Fund invest in that over the years. And they still continue investing in community health work as in my country. Right now, President Ruto is very focused on on.
Maureen Murenga: I mean, universal health coverage, Usc, but he’s using the community health workers is now calling them community health promoters. But still Global Fund is significantly funding that aspect of of the program. We have also seen investment in Rss with stronger health systems. And you know, II just realized that when the health systems are stronger, the diseases are fewer.
Maureen Murenga: Our hospitals are not as jammed as they were during that time. When we used to be asked to take our people back home. So we have seen the health systems getting stronger. Community systems are also strong at the community level. Promoting prevention of diseases. Communities are more resilient, and that is because of the Rss. It has a component of community system strengthening. So communities are more resilient, too
Maureen Murenga: prevention and to deliver health services at the community level, building on them. On the filler of universal health coverage. So I can say that Usc is also about equity Maureen Murenga: and addressing the drivers of the diseases. And we have seen how Global Fund has invested in human rights
Maureen Murenga: gender equality. And and this has ensured that everyone, regardless of their identity, are able to access services regardless of the economic
Maureen Murenga: some people could not or still cannot, afford the kind of treatment they need to keep them alive. They’re still able to do that, and also that geographically doesn’t matter where you come from. You get an opportunity to access treatment and to live longer. So I think that just by creating that form of equity Global Fund is contributing significantly
Maureen Murenga: to having a universal health coverage that ensures no one is left behind. So I want to agree with everyone that what Global Fund does contribute to? Uhc.
Maureen Murenga: I don’t think there’s any healthier competition. Compared to investing in health of them, I mean investing in the most deadliest diseases of this world, because these diseases contribute significantly to the health and well being of any society.
Maureen Murenga: By eliminating HIV, Tp and malaria, you increasingly eliminate a whole chunk of sick
Maureen Murenga: of of hospital demands and health, because these diseases are interconnected with other human diseases. If I don’t address HIV, I’ll get Tp. I if I and I’ll get other diseases like pneumonia, diarrhea. So it it is a a Co, a complex kind of cycle of diseases that are encompassed with the 3 deadliest diseases or 3 deadlines, epidemics that Global Fund is addressing. So as affected communities. We believe that Global Fund is taking a huge chunk.
Maureen Murenga: In ensuring that we have healthy societies. We have strong communities and people, regardless of where they are, are able to access health services. And this is what we call Ulc from our terms. So that is Global Fund share of contribution to Usc, and I don’t think the private sector should worry about investing more in that, because it is a preventive kind of
Maureen Murenga: investment as well. If most of us are not, then we are able to contribute to the society and to your company. So thank you very much.
Chris Collins: So much, Maureen, for that wonderful comment. And you know, I just, I wanna say, too, you know, the Global Fund is a partnership. It’s all about partnership. And everybody who’s speaking on this webinar today is a critical part of that partnership. And in making that dream happen. So I just wanna thank all of you for all those comments.
Chris Collins: Now, to close this out with some
Chris Collins: concluding thoughts is Rob Hecht, and he’s president of Pharaohs, global health advisors. And I want to say also, Rob and Farrows helped a great deal with our report, and I really appreciate his contributions and Shun’s contributions as well to make the report possible. So thanks so much to both of you, Rob, over to you.
Robert Hecht: Thank you. Thank you very much, Chris, and it’s hard to follow all these brilliant and passionate comments.
Robert Hecht: In full disclosure. I’m glad you mentioned, Chris, that we had provided some technical support to this work, but it’s not our report, it’s yours. So we’re we’re just happy to be a contributor. Robert Hecht: Alright.
Robert Hecht: let me say a word about why I think this report matters, Chris, for you and for everybody else on the line. To me it’s a sympathetic
Robert Hecht: but independent and data driven. Look at the Global Fund and how it is contributing to universal health coverage mainly, but not exclusively, through this pathway of health system strengthening. And in that sense I think it’s quite unique. In what it, in what it covers and what it says. So
Robert Hecht: I just want to Robert Hecht: highlight the significance of this work and put it in perspective. In my remaining 4 and a half minutes. I just want to touch Chris on 5 or 6 things that you might
Robert Hecht: not have known about the Global Fund before you read this report, things that I think shed new light on the Global Fund, and it’s
Robert Hecht: accomplishments and its capabilities. The first one has to do with scale sean and others mentioned 1.5 billion dollars, perhaps 2 billion. If you include the COVID-19 response mechanism funding that Robert Hecht: portion of the Overall Global Fund portfolio that is really dedicated to health system strengthening. That’s about 5% of all
Robert Hecht: international assistance for health. And that makes the Global Fund a very major contributor to health systems strengthening and to development, assistance for health overall. And I’m not even counting the money that is classified as being more disease focused, which is even larger.
Robert Hecht: So that’s one thing you might not have known. Secondly, did you know that the Global Fund, in addition to working at the country level, really is helping to create these so-called global public goods or things that benefit all of us through its investments. You mentioned, Chris, I think the
Robert Hecht: the health management information systems, the facts that the DHIS. 2 is heavily, heavily supported by the Global Fund and
Robert Hecht: being implemented with Global Fund support in in many countries across the world. The same is true for the Global Fund’s role in so-called market shaping or getting us better, better, more reliable prices for things like malaria bed nets. That’s because of the Global Fund that doesn’t just benefit Mozambique or Malawi, or any individual country, but it benefits everyone.
Robert Hecht: A third thing you might not know is how important the global funds contribution has become in human resources for for health. You have those 10 areas. But I’m just gonna pick out 2 or 3 very quickly. The fact that the Global Fund was heavily responsible for the training of this very vast community health worker force in in the Dr. Congo, in the Democratic Republic of Congo, and that it basically has kept Zimbabwe’s
Robert Hecht: health system afloat for the last 5, 10 years. As Zimbabwe has gone through very tough economic and fiscal times. This is again the Global Fund that’s come in, not as a long-term solution, but as a very critical stop gap gap, without which all health services in Zimbabwe would be seriously compromised.
Robert Hecht: Did you know about the the global funds contribution? As I said, to the health information systems? There’s the example in the report of how working on an integrated health information and surveillance system not only covers things like Aids, Tb. And malaria, but also childhood immunizations, and also neglected tropical diseases like on oncosis.
Robert Hecht: So this is again a contribution of the Global Fund. You might not realize at first glance the expanded role of the Global Fund in working with oxygen therapy.
Robert Hecht: Started under Covid. But a huge investment over 600 million dollars so far, and counting to help countries with respiratory failures, not just from covid, but from
Robert Hecht: childhood, pneumonias and obstetric crises, and a whole series of needs in surgery where oxygen is critical. This goes well beyond Aids Tb. And malaria, and I think the report mentions the major contribution of Global fund to oxygen in Kenya.
Robert Hecht: And then, finally, I heard Sarah Bolton mentioning sustainability and and domestic financing. The report brings out the fact that the Global Fund has been crowding in and encouraging more national spending Robert Hecht: in health systems, not only for the 3 diseases, but also explicitly
Robert Hecht: for health systems strengthening that goes beyond the 3 diseases that’s measured by the Global Fund as part of its contribution to financial strength and capacity building working toward Uhc.
Robert Hecht: So I just wanted to mention those Chris as things that people might not fully be aware of. And when you’re talking to your friends about the Global Fund after this report is fully circulated, you might want to highlight that there’s some things about the Global Fund health systems in Uhc that most people don’t know that need to be better understood.
Robert Hecht: So I’m gonna stop there. I think the Global Fund can always do better in these areas around health systems Shun and his team are, and and no one is more aware than they are of the the ways in which the Global Fund wants to do more and do better. So there’s still some distance to travel. But I do think the Global Fund needs to be recognized as a very major player in health systems. And in this regard it’s contributing to a Universal health coverage. Thank you.
Chris Collins: Wonderful. Thank you so much, Robin. And again, thank you so much for your help with the report we’re ready to go into QA. Before we do that, I wanted to say, I do hope everybody can access the report and share it. It’s@theglobalfight.org on the web. The friends website. In addition, I want to acknowledge a couple of people. Mike Isabelle. Worked very hard on this report and made a huge contribution to making it happen with the friends team. So thanks. Mike
Chris Collins: and aria bias of our Communications team has been essential in setting up today’s webinar. Thank you. Aria. So let’s go to questions that we’ve received. And the first one is from David Brydon. He says it’s exciting that Global fund investments in health systems and Ppr
Chris Collins: pandemic preparedness are increasing. How will the Global Fund Governments model adapt to this shift? Will the Global Fund Board and Ccms include independent experts in these areas or community representatives, such as health workers, primary care advocates, or others with a broader role than for specific diseases that sounds like something for shun.
Shunsuke Mabuchi: Thank you. Happy. It’s high. Sorry. Happy to take that question. You will be Shunsuke Mabuchi: okay. Okay. Chris Collins: Yeah. We hear you. You’re good. Shunsuke Mabuchi: Okay? Great. Yeah, sorry I’m I’m with Rob. So we are now doing some mic mics changes.
Shunsuke Mabuchi: So this is exactly the topic that we have been discussing, and we had just had a very informative workshop with countries. Partners and the our secretariat team. But maybe one thing to highlight Chris Collins: shun, are you there? We you’re freezing.
Chris Collins: so shun froze there for a minute. So why don’t we come back on this question and go to the next one? From? Chris Collins: Do we? Let me see if Shannon well, let’s go on.
Chris Collins: So what do experts here think of the role of the human Rights plays in achieving? Uhc, and how big of a role does global fund play in that area? And can you speak to human rights dimensions of Uhc and and how Global Fund is supporting communities and countries. And that these questions come from Mandy and Gisa.
Chris Collins: Does anyone want to speak to those those areas of the critical role of of human rights in Uicc. Chris Collins: Rob, go ahead. Chris Collins: A comment from our panelists on human Rights and UHC.
Chris Collins: I would say, you know, this is one of those areas where the Global Fund, I really think, has always placed premium, and, in fact, has dedicated programs to advance the human rights environment
Chris Collins: in countries. And in addition, has really emphasized reaching the most vulnerable and having particular programs in place that can reach the most vulnerable and marginalize folks in their societies. So I think
Chris Collins: the Human rights perspective is sort of part of the DNA of the Global Fund, and one of those areas, I would argue, needs to be part of the Global Fund. But also we need to take out more broadly as we build Uhc and pandemic preparedness. They’ve got to be
Chris Collins: founded in human rights. And it’s one of the things the Global Fund tries to get right. Chris Collins: I see you’re back with us. you want to give another try on that. Apologies. Chris Collins: Don’t worry.
Shunsuke Mabuchi: yeah. So what I was going to say was, we really intentionally engage with the health system entity to lead the implementation. Shunsuke Mabuchi: and then, the meet in in terms of Ccm.
Shunsuke Mabuchi: conversation. We already have Ministry of health representative in most of the countries. But what’s really critical is the voice and commitment from the senior management of the Ministry of Health to really engage in the health system work. That is something that we are working on, what we can do to further enhance it.
Shunsuke Mabuchi: So there has been some good changes in the implementation arrangement that we have been pushing and COVID-19 resources actually has been really helping Shunsuke Mabuchi: on that. Thank you. Chris Collins: Wonderful, Rob, go ahead. Chris Collins: Rob, did you have a comment?
Robert Hecht: Alright, yes, I’m back. Sorry I, Chris. I just wanted to add to what you were saying on the human rights issue. I thought your answer was spot on. I just wanted to add that 2 things, one is that
Robert Hecht: for those of us who work a lot on Uhc, and trying to put it into practice. Robert Hecht: In all countries the commitment to Uhc is really grounded in a human rights argument about the the right to health for everybody
Robert Hecht: access equity. And so on. And in in my experience, working with the Human Rights groups that the Global Fund supports. The the call for that type of
Robert Hecht: broader equitable access to health services accompanies the the human rights arguments around key populations and other stigmatized groups, and so on. So I see it really as part and parcel and a natural area for Global fund and for Global Fund, Human rights
Robert Hecht: analysts and advocates and and and other groups to support. Thank you. Chris Collins: Wonderful. Thank you. Okay, let’s let’s go to
Chris Collins: We have another question from Annette. What can we do to make sure? Community health workers are not only paid but paid a living wage. Community health workers not only often come from impacted communities, they are irreplaceable and irreplaceable. Entry point into health systems. For many people no wor health workers should be left behind.
Chris Collins: Any comment. Several of us have talked about the the absolutely essential role of community health Workers and Increasing Global Fund support in that area. But Maureen, others any more to say about Chris Collins: community health workers, compensation and other issues. Dr. Sabeen Afzal: Matt.
Chris Collins: yes. Oh, please, Dr. Please go ahead.
Dr. Sabeen Afzal: In Pakistan. The lady health worker were initially when the program was created was more a stipend based program but after 2,012 we have regularize all the lady health worker across the country, and we have around 100,000 lady health workers, and they cover around 60% of the rural Pakistan. And we are very Populist
Dr. Sabeen Afzal: pop this country. So there’s a large number of population. They cover after covid. And when we Pakistan develop the central package of health services we had. We’ve a fifth evaluation of our lady health workers, and we have,
Dr. Sabeen Afzal: there were many key recommendations, for there, based on those Re key recommendations, we have revised their curricula. Their manual, and have included many things keeping an emergency their role in emergency, preparedness and prevention, and engaging them in with more integrated approach. Through course of life
Dr. Sabeen Afzal: rather than where initially they were more focused on Rmlch services. But now they are looking at more integrated approach, and there is a counseling card and everything. It’s mainly in Urdu. So even if somebody want to reach it, they it’s available on our website in the knowledge help so like payment. In most countries
Dr. Sabeen Afzal: unlike other countries in Pakistan or the lady health workers are regular paid. Let’s say, employee of the health system. Dr. Sabeen Afzal: I’ve stopped here. Chris Collins: Wonderful. Thank you. And Chris Collins: shun did. Did you have your hand up?
Robert Hecht: Thank you. Yeah. So just to add to Dr. Fauxaw, who actually explained an excellent example of the community health workers Robert Hecht: our approach. What we are trying to help countries is really on that point, to Robert Hecht: make sure that community health workers are
Robert Hecht: well supported. That means the contracted as a regular health workforce Robert Hecht: paid on time. Robert Hecht: To the country system. and how equipped Robert Hecht: with the sufficient commodities and the drugs and tests. and then support it through the super regents and push it aside
Robert Hecht: the immunization and Ipc measures. So those are the key element of the maturity of the community health record system that we are aiming to support. So whenever we have
Robert Hecht: investment in community health workers, which is huge now about probably about 900 million dollars in the next 3 years or so. We really look at the maturity of the system and support to advance that health worker system of the country and really led by the Country Community health unit done. Ministry of Health.
Robert Hecht: Thank you. Chris Collins: Great, thank you. And and I see a comment written in by Maureen Maranga. It. You know the that, she says communities need to be more engaged in advocacy for domestic resource, mobilization and country level negotiations. Different countries have different models of recognition of community health workers.
Chris Collins: And just to say, Maureen really has been a pioneer in terms of domestic resource mobilization in her own country. And and we wanna thank her for that. We’ve got 3 min left. That’s probably time for one more question.
Chris Collins: So another question for David. A crucial step in reaching Uac is providing universal access to health insurance as seen in Japan and other countries. How is the Global Fund contributing to the effort to establish comprehensible and affordable health insurance in Lmi C’s low and middle income countries. And I would note we have, we will stop right at the hour. So we just have a few minutes.
Chris Collins: So on this question of health insurance is Eric comment. Robert Hecht: I’m happy to respond. Please.
Robert Hecht: yeah. So the Global Fund main approach to health systems now, is really to support the key function of the health system. That contributes to HIV, Tb. And malaria. And then the broader health outcomes. So we really take the approach of supporting key functions like global systems, surveillance system, oxygen or respiratory care system to build the
Robert Hecht: its maturity over time through the long term investment. So we are less focused on the health insurance, although here we acknowledge the importance of supporting the health insurance system. Myself came from the the World Bank that supports the those investments.
Robert Hecht: So as we go forward we support, together with the World Bank, to blend the finance on the more integrated package of care that also includes some health insurance package. So we may further increase that kind of collaboration to leverage the strength that the World Bank has, and then make sure that our support, which is the key vulnerable population, and HIV, Tb. And malaria constituencies too
Chris Collins: wonderful. Thank you, shun.
Chris Collins: We’re at the top of the hour. I wanna thank everybody who’s been part of this. It’s been a really wonderful discussion. And just thank you for everything you’re doing to advance health equity for people around the world. Thanks to everyone who’s joined. Please do access the report. We welcome your comments.
Thank you so much, and have a great day. Dr. Sabeen Afzal: Thank you. Thank you. Thank you.